One of the critical questions to ask when reading a medical journal article is: Who funded the study? In most journals, researchers are required to identify their sources of funding. So, what’s the problem? Well, researchers can obscure the true origin of financial support—they can hide it, disguise it, or even launder the money through a front group. Case in point: a study downplaying the risks of lung cancer, funded in part by the Foundation for Lung Cancer: Early Detection, Prevention, and Treatment. That doesn’t sound so bad, until you realize it’s underwritten by millions from a tobacco company. See, there’s no obligation to disclose a funding source’s source of funding. This allows companies to evade financial disclosure requirements, and makes it harder to follow the money trail.

Why does the funding source matter? Every single one of eight reviews, covering over a thousand studies, found that research funded by industry is more likely to make conclusions that are favorable to industry. For example, why do some review articles on the health effects of secondhand smoke reach different conclusions than others? The only factor was whether an author was affiliated with the tobacco industry. This is a disturbing finding. It suggests that, far from conflict of interest being unimportant in the objective and pure world of science, it may be the main factor determining the result of many studies.

Not that you’d even know, because 77% of authors failed to disclose the sources of funding. And that’s another problem—the responsibility to disclose funding sources is left entirely up to the authors. So, how many researchers divulge the truth?

Evidently, a law was passed in Denmark requiring physicians to register any time they worked with industry, which allowed researchers to cross-reference the studies they published to see how honest they were. And 48% of the time, the conflicts of interest were not disclosed, reinforcing the perception that physicians simply don’t take conflict of interest seriously—or at least Danish physicians.

What about the U.S.? We didn’t know, until this study was published. Historically, there’s been no means of confirmation or verification when an American doctor said they had no conflict of interest. But then, in 2007, hip and knee replacement companies were forced to pay hundreds of millions of dollars in fines for giving orthopedic surgeons illegal kickbacks. Many orthopedic surgeons made decisions predicated on how much money they could make, choosing which device to implant by going to the highest bidder. “We expect doctors to make decisions based on what is in the best interests of their patients,” said the Department of Justice, “not the best interests of their bank accounts.” And part of the settlement was that they would have to make public all the payments they made to physicians. The release of those records offered a rare opportunity to see if physicians were telling the truth on disclosure forms. And, lo and behold, more than half of payments were not disclosed, totaling millions of dollars.

Now, this was for surgeons and medical device companies. What about doctors and drug companies? The same thing happened where drug companies were forced to disclose who they were paying off. They looked at the publications of the doctors that got the most money—at least 100 grand. And they were worse than the surgeons. In 69% of the cases, they failed to disclose their industry ties. The problem is that we just assume researchers are going to be honest and tell the truth, but these findings suggest that the accuracy and completeness of conflict-of-interest disclosures cannot be assumed. So, even when a paper says no conflict of interest, who knows if it’s really true?

Long-time editor-in-chief of the New England Journal of Medicine wrote a scathing piece on drug companies and doctors who failed to disclose hundreds of thousands of dollars from drug companies like GlaxoSmithKline, which has been fined literally billions of dollars for things like bribes and suppressing data. When they got results that were commercially unacceptable, they just buried them. Billions in fines, but for drug companies, that may just be the cost of doing business. As reprehensible as many drug industry practices are, the medical profession may be even more culpable—I mean, you expect drug companies to prioritize the bottom line, but maybe we should expect more from the healing profession.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

One of the critical questions to ask when reading a medical journal article is: Who funded the study? In most journals, researchers are required to identify their sources of funding. So, what’s the problem? Well, researchers can obscure the true origin of financial support—they can hide it, disguise it, or even launder the money through a front group. Case in point: a study downplaying the risks of lung cancer, funded in part by the Foundation for Lung Cancer: Early Detection, Prevention, and Treatment. That doesn’t sound so bad, until you realize it’s underwritten by millions from a tobacco company. See, there’s no obligation to disclose a funding source’s source of funding. This allows companies to evade financial disclosure requirements, and makes it harder to follow the money trail.

Why does the funding source matter? Every single one of eight reviews, covering over a thousand studies, found that research funded by industry is more likely to make conclusions that are favorable to industry. For example, why do some review articles on the health effects of secondhand smoke reach different conclusions than others? The only factor was whether an author was affiliated with the tobacco industry. This is a disturbing finding. It suggests that, far from conflict of interest being unimportant in the objective and pure world of science, it may be the main factor determining the result of many studies.

Not that you’d even know, because 77% of authors failed to disclose the sources of funding. And that’s another problem—the responsibility to disclose funding sources is left entirely up to the authors. So, how many researchers divulge the truth?

Evidently, a law was passed in Denmark requiring physicians to register any time they worked with industry, which allowed researchers to cross-reference the studies they published to see how honest they were. And 48% of the time, the conflicts of interest were not disclosed, reinforcing the perception that physicians simply don’t take conflict of interest seriously—or at least Danish physicians.

What about the U.S.? We didn’t know, until this study was published. Historically, there’s been no means of confirmation or verification when an American doctor said they had no conflict of interest. But then, in 2007, hip and knee replacement companies were forced to pay hundreds of millions of dollars in fines for giving orthopedic surgeons illegal kickbacks. Many orthopedic surgeons made decisions predicated on how much money they could make, choosing which device to implant by going to the highest bidder. “We expect doctors to make decisions based on what is in the best interests of their patients,” said the Department of Justice, “not the best interests of their bank accounts.” And part of the settlement was that they would have to make public all the payments they made to physicians. The release of those records offered a rare opportunity to see if physicians were telling the truth on disclosure forms. And, lo and behold, more than half of payments were not disclosed, totaling millions of dollars.

Now, this was for surgeons and medical device companies. What about doctors and drug companies? The same thing happened where drug companies were forced to disclose who they were paying off. They looked at the publications of the doctors that got the most money—at least 100 grand. And they were worse than the surgeons. In 69% of the cases, they failed to disclose their industry ties. The problem is that we just assume researchers are going to be honest and tell the truth, but these findings suggest that the accuracy and completeness of conflict-of-interest disclosures cannot be assumed. So, even when a paper says no conflict of interest, who knows if it’s really true?

Long-time editor-in-chief of the New England Journal of Medicine wrote a scathing piece on drug companies and doctors who failed to disclose hundreds of thousands of dollars from drug companies like GlaxoSmithKline, which has been fined literally billions of dollars for things like bribes and suppressing data. When they got results that were commercially unacceptable, they just buried them. Billions in fines, but for drug companies, that may just be the cost of doing business. As reprehensible as many drug industry practices are, the medical profession may be even more culpable—I mean, you expect drug companies to prioritize the bottom line, but maybe we should expect more from the healing profession.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

175 responses to “Disclosing Conflicts of Interest in Medical Research”

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Unregulated free markets are blind to ethics. They only operate in the public good so long as there is free entry to them so that competitors can try to outdo each other. There is not free entry into heavily capitalized businesses like drugs and medicine, however, so these industries are natural monopolies and can do whatever they can get away with on a grand scale. A lot of industries these days become antisocial as well as toxic, since modern industry uses techniques that favor large scale only operations, and prevents action against them by competitors. Unregulated, they have become not only toxic but even anti-social.

Yes, the FDA was setup to assure the success of agriculture and related (or not so related) busineses, and not the public health. Putting them in charge is wrongly- assigned regulation, about as backwards as it gets. But it is typical of a poorly educated citizenry that spurns and neglects its governments.

Yes and there are many more examples of them ruining the public’s health through endemic and institutionalised corruption. To pretend that “nothing” would the result of getting rid of the FDA, suggests to me that people are incapable of replacing a dangerous organisation with a more accountable one.

This is so embarrassing for the medical profession – a healing profession turned in to money buisness….
The biggest problem is that you have to trust your doctor when you have a disease. No one – unless you have experience in the particular field of your disease (as a MD, nurse or another healthcare professional) – has a chance to evaluate the suggested treatment. Thinking that you can google the answer is very naive. Understanding complex issues requires a basis of knowledges. A MD getting a disease outside his/her field also have to trust their doctor, because experience is so important in the treatment of disease. My best advice: STAY HEALTHY!

Mercola has a big dollars sign in his eyes, can’t you see it ?
Dr Shealy you mean this one ?
Lots of crap on their websites to sell to the deluded mind..
It’s smell like snake oils in the realm of crooks !

The ones you should trust rather than going into a purchase rampage are:
Dr John McDougall, Dr Michael Greger, Dr Caldwell Esselstyn, Dr Neal Barnard.

Dr Mercola is a decent man. Just because he sells supplements on the side does not make him into a snake salesman. Dr Fuhman, a good friend of Dr Greger, constantly pushes for his seminar at some expensive resort in Italy, or his foods or supplements.

Dr Greger can make a living on donation but he is unique. Everybody else needs money to survive.

Jimmy: Correction: Dr Greger does not “make a living on donation”. Dr. Greger makes his living with a day job. He works for his living, and there is nothing unique about that. Any doctor could support themselves with patients and give nutrition information out for free if they wanted.
.
Note that Dr. Greger donates his time to educate people on nutrition. Dr. Greger has no conflict of interest when it comes to educating people. Other doctors do have some level of conflict of interest. The question is, how much is the conflict.

Indeed, except if you sell crap and lie in order to be rich.
Many of the top world fortune are based upon the exploitation of others.
Pretty hard to find billionaires who don’t have a skeleton in the closet.
Not saying it doesn’t exist, though.

Jimmy, in my opinion, the definition of decent is very elusive. One may start out confident that he is doing the right thing for the public, but once he is massively remunerated for specific products that he sells or promotes, what are the chances of his withdrawal when he discovers that most evidence shows them to be harmful or ineffective? In fact, what are the chances of him admitting that to himself when these sales are one of the main sources of his and his family’s wealth?

You can talk about different opinions and a website “dominated by vegans” all you want, but it was science and evidence that led Dr Greger and other devoted scientists to recommending WFPB diets for optimal health, not some kind of preset ideology. And there’s plenty of room for discussion and disagreement, but the foundation of a healthy diet has been known for decades.

Whether Dr Mercola is decent or not, he promotes (at least some) foods and supplements that are proven to make people sicker in the long term, not healthier. I don’t think the corruptive power of money can be ignored in this context.

Thanks but no thanks for the budget advice. Keep your scorn to yourself and someday maybe you can read more.
Dr. Mercola has taken on big medicine and Monsanto with the best of them and offers personal care products I simply can’t find elsewhere/don’t trust. Dr Shealy is a trained neurosurgeon and chronic pain expert way ahead of his time in regonizing the role of the spirit in human health.

They all start out wholesome genuine and then turn into capitalists (publishing a book is one thing, but marketing their own line of supplements e.g. — which are “proprietary blends” built on mere Vitamin C is crookery). The trick is to learn that they are all presenting the same concepts. Self-educate and practice the concepts. You don’t need to buy their products to learn.

The one thing I have learned in life is that it is almost ALWAYS about the money. Follow the money and you get your answer.
A particularly egregious situation is the oncology discipline in medicine. Oncologists routinely buy their chemo drugs at wholesale cost from the pharm company and mark it up to the insurance companies (or you if you are private paying) and get kickbacks. 60 Minutes did a very revealing piece on this situation. And the situation continues to go on.

The only way, in my opinion, that this kind of money-incentive is going to change is if people start going to jail for fraud. I know that if I performed fraud in my community, I would be in jail. As we see from the financial meltdown of 2008 banks are just paying off their fines. No one is going to jail for their actions. And the dubious behavior of the banks continues.
When individuals in positions of trust who fail that trust start going to jail (white collar crime) then we may see some change. But meanwhile priests, bankers, and, yes, physicians, are going to be on the take I am sad to say. As always, buyer beware.

That’s why I am all for privatizing the medical healthcare and insurance. For instance with my company insurance which is private, they scrutinize how often can I see a doctor, what drug do I take for certain medical issue, how much doctor can charge me… In another word, let another fox (insurance company) guard another fox (pharma co and doctors).

It already is privatized. That’s the problem. We pay for all the separate insurance companies to do paperwork and find ways to deny people. That’s their goal. Single payer is way cheaper and better quality.

When you say it has worked, it has worked to give us the most expensive health care by far anywhere, and among the least effective of all industrialized countries. The most efficient private companies mostly become experts at picking really healthy people and denying expensive people, who don’t get health care.

All countries except us only pay up to a certain amount for healthcare. And they don’t keep people alive on tubes when there is no chance of recovery. And they don’t prescribe pain killers and abuse the system the way that we do.

If medical insurance companies were really interested in reducing medical costs they would primarily be focused on reducing chronic disease rates, not just guarding the other foxes in the medical industrial complex. If they were actually interested in keeping people healthy, they would all be on board with the recommendations of Kaiser Permanente and up front say that everybody should be following a WFPB diet since the unbiased science paints a very clear picture of what is and what is not healthy to eat.

But a healthy population with the minimum rates of disease isn’t how insurance companies make money. They make more money when disease rates are high and people need lots of medical care. This is because they keep a pretty fixed percentage of the health care money as it flows through their companies. So the more disease, the more money flows through them to medical providers and pharmaceutical companies, the higher their net revenues. So they really don’t have a strong incentive to fundamentally change the basics of the system and so they play at the margins with micromanagement of what and how medical care gets delivered.

Just to be fair to doctors and insurance companies and a lot of so called experts out there, sometimes they are ignorant and don’t know themselves and their knowledge is probably outdated from 40 years ago when they were in school and they were indoctrinated themselves and believe in drugs. Take for example my doctor, he is conscientious and not into money but he wants to prescribe me medication at any chance he can to “make me better”. Or I read in the news the other day that a lady who is CEO or VP of a big drug company has resigned to take care of her mother who has cancer and she will probably gives her mom the same harmful drugs that her company makes.

Not to be political, I like the idea of Governor Kasich who proposed during the GOP primary that each person will be allocated a fixed amount of money for their healthcare and the more they stay healthy and not requiring any hospitalization and medication while they are young, the more money they have left for their healthcare when they get old. That will give incentives for people to stay healthy.

But what about those with say childhood leukaemia, or involved in a massive trauma accident? It’s an incentive in theory, but I wonder how realistic it could be in practice… Is it ethical? Like your first heart attack (where you may be naive) to say Vs your 5th or 6th type thing… hard to draw lines and say oh you are dying but your health money is empty… sorry!

I don’t know all the details because I am no sick, fortunately. But at my work place, there are people who are seriously sick, like having cancer or HD. I don’t hear from them that they run into limit that they cannot do certain procedures because health insurance does not pay. For sure cancer will have higher limit for coverage than dental work.

Anyway, this is not the subject here that we are trying to find the solution for the best and most cost effective healthcare but we are merely talking about incentives to make people staying healthy rather than just depending on drugs and more hospitalization and more pain killer and so on.

It’s definitely encouraging to see kaiser on board however yes… whilst I believe they have advantages at a company level (reducing premiums if staff our healthier)… the overriding profit incentives are higher at a hospital level.. sad really… do you have any ideas how this could work? I feel sometimes they almost can ‘allow this help’ as the hospitals are so overrun with waiting lists that they have virtually unlimited income so can be seen to be ‘trying’… as they feel it won’t really affect their bottom line…

Insurance companies have no business being involved in healthcare. They profit off of denying care. They have contributed to the skyrocketing cost of healthcare. There is absolutely nothing good about health insurance companies.

It has worked for 100 years or longer. The private companies watch their insurance company they have under contract and the insurance companies watch the doctors. Ask people who have a job at a private company that has health insurance, it works. Because they all do for profit.

Sorry Bud. You are completely misinformed.
1. I have private insurance. When my husband had a valve replacement (bicuspid) we had a 15,000 copay.
2. I am a health care provider. To get care OKed you need to talk to a pencil pusher.
3. They are not qualified to watch doctors.
4. They should not be making a profit by denying care.
5. As a patient I see doctors who generally not covered because they do not contract with my insurance company (Anthem) which means I pay out of packet.

Over the years, I have spent so many hours of frustration dealing with health insurance companies. From my experiences I think they must have protocols to send us on wild good chases, deny valid claims and make us jump through hoops to get our expenses covered. Absolute nightmare.

Really? Government delivered or managed systems seem to do a lot better than the largely private US system if the international comparisons are in any way meaningful. They deliver better health outcomes and are much more efficient.

I realise that this doesn’t accord with the free market propaganda of those who want a free licence to exploit the sick and dying for profit but how else can we explain the observed facts?

I never believe anything run by the government. The problem with our healthcare is not because of our government or private company, but it has to do with fraud and loophole that allows abuse. On one hand, there are people with no healthcare at all, and on the other hand, people who have are abusing it, or the doctors and hospitals abuse it. I don’t want to get into a long discussion here about where it’s coming from and how to fix it.

But just take a look at how it is done with private companies for hundred of years. For companies that provide health care insurance, they manage well enough to stay profitable and at the same time provide adequate health care for their employees. I know a lot of people who also works but at small companies who have no health insurance. They are not poor enough to be on medicare but not rich enough to afford buying their own health insurance. Obamacare is supposed to plug this hole.

I read in the news years ago that an executive cannot find a job again, so he works as a minimum wage clerk at Target, not because of the salary, but because of the health insurance. So it means that Target provides adequate health insurance even for their low level workers.

In short, there has never been inadequate health care or abuse at private companies that provide health insurance.

I don’t think that is correct. You will always find somebody complaining that the coverage was inadequate or there was an abuse of process. In any case, private companies go bankrupt – what happens to employees’ benefits then?
In any case, most of these private companies do not provide the actual healthcare/insurance the. Instead, they contract it out to a third party such as an insurance company or HMO. Even the huge US military healthcare system, TRICARE, contracts out many of its core functions to HMOs etc.

OK let’s not discuss semantics here because it will lead to nowhere. I don’t care if it is run or monitored by the government or private companies, it’s not really important. What I am getting at is the healthcare system should be run like how it is run currently at private companies, whatever it takes. At the same time that there is no fraud, no overbilling, there is also no abuse from both sides, the doctors and the patients, while providing adequate health coverage for what is absolutely needed. At least at the company I worked, I never feel that I am not getting the medical care I need, nor do I hear any complaint from co-workers who have more serious health issues like cancer or heart disease. At the same time, there is a cap to everything and I cannot abuse the system, like having 10 root canals in one year or getting pain killers constantly for my drug addiction. Either I choose an HMO plan that has their own hospitals like Group Health or Kaiser or I can choose a PPO plan like Aetna that has a network of doctors and hospitals that I can go to. Those doctors are probably chosen by the PPO plan based on their past records of not abusing the system. But at the same time, I was never denied by my doctor for any medical attention I need, such as asking for a battery of tests when I have no proof of any diseases but just symptoms from aging. So it has worked without any problem in the private sector for 100 years. It’s when you get to Medicare that you see fraud and at the same time not providing adequate medical coverage for people in needs. I am not a politician nor an expert to analyze where the problems come from and how to fix it but I know that it can be done.

Now for the prevention of diseases through nutrition and lifestyle, this is a different problem. It’s not entirely due to big pharma or doctors who intentionally cheat the system or harm people with all these drugs but it is mainly ignorance. Like Dr Greger and a number of health doctors said all the time, there is hardly any nutrition course at medical schools and so doctors are trained to give medication and not advising people on lifestyle changes. They likely don’t know it themselves. My own doctor wants to prescribe me medication to make me “better” all the time but he never advised me on nutrition. I learn it all by myself, thanks that there is the Internet today. If I aged let say 20 years ago, I would be dead by now or I will be hooked on medication. My own doctor shows signs of aging himself but I am sure he won’t listen to my “medical advice” if I will try to give it to him. None of my co-workers believe anything I said, they just pop this pill and that pill in their mouth, or have steroid injection into their knees for their joint issues and I read that it will destroy the ligament overtime but they probably don’t care because they are either dead by then or sit in a wheelchair. Not me.

So the big problem that we have now in our healthcare system is not simple to fix. People need to be educated and take care of their own health. We can start with a little step at a time, like Dr Greger and a number of other health doctors are doing to educate people about nutrition. But we need to immediately put control on this healthcare system that is on the verge of bankruptcy while our life expectancy is the lowest of any industrial countries. And 5 year old getting cancer or diabetes.

Jimmy please. “I don’t care if it is run or monitored by the government or private companies, it’s not really important.” That one sentence demonstrates that you are confused. If it is monitored by the government it is done so at a lower cost. (Medicare and Medicaid) That is how money is saved. A private insurance company makes a huge profit. That is why our system is so expensive. Yikes!

Go get a book on the history of private insurance companies. They haven’t run as you think.

They came about after the war when employee pay increases was put on hold. So businesses gave other “perks” including health insurance. Prior to that people paid “out of pocket.” And yes that may have been with vegetables from the garden or a homemade pie if they didn’t have any money.

Insurance companies are in the business to make a profit off of people health. That last sentence alone should give you pause.

I don’t know the details of how the private companies manage their health insurance but they have to be profitable and at the same time provide adequate health insurance to keep their employees happy. I worked for a number of private companies and health insurance is always well managed. Perhaps because I am in a high paying job. Just kidding. Anyway, I am all for privatization because private companies watch their pocket book.

Yes there is limit to what and how many procedures I can have per year. For instance if I remember correctly, I think they allow 1 root canal per year.

But do you agree with these blanket statement rules? Like what if you need 3 root canals? Or literally cannot afford the health care you need. Let’s go with root canals required from a car accident as an example…. it’s more black and white as it’s an accident, nothing to do with their lifestyle and the person is say a dental student, so low income…. It’s a very difficult situation I feel…

“But do you agree with these blanket statement rules? Like what if you
need 3 root canals? Or literally cannot afford the health care you need”

Yep I know but we have to face with reality and society cannot afford to provide everything for everybody all the time. I deal with this kind of restrictions all the time with private companies. Usually when I has a job offer, I will evaluate not just based on the salary but also on the benefits package including health insurance. For instance, dental is max 4000 per year (just an example) and if I do dental work for cosmetic reason, then I will run out of money for my root canal if I need. I either wait until next year to do my next root canal or pay from my own pocket. Such is life.

People think that private companies are some kind of ivory towers when they are not. I visited some sick relatives who are on medicare and I saw the nurse going into their room every 15 minutes to check the vital signs of the patients. I think they are abusing the system to charge more to medicare.

All European countries have restrictions in their coverage although health care is free.

I can think of so many examples and stories from people who needed health care while traveling. I just had a patient who was in China. He developed a swollen, infected eye. He was seen, given medication, and paid 5 dollars on his way out. It would have been waaay more expensive here. Hundreds of dollars. Yes maybe part of that would have been covered if you had met your deductible. Trust me Renae, it’s a mess here. I envy your health care system.

I’m genuinely curious what ideas you have as a solution? How would you do it? For example I’m from Australia where we still have ‘free’ medicare healthcare for all… Basic public hospitals and family practice is covered or highly discounted (gap payments). But many treatments such as immunotherapy, elective procedures, non-emergencies either can only be accessed on clinical trials, compassionate grounds, out of pocket payments (thousands), or high level private health insurance (often still with out of pocket costs)… it’s such a delicate balance between ‘everyone deserves the health care they (legitimately) require, Vs abuse of the system…

It is not really free. We all pay into the system via general taxes and specific Medicare levies. Essentially we are members of a giant national HMO scheme – one that can negotiate very large discounts for drugs, surgical devices and hospital services because it is essentially a monopsony.

As a consequence, all such national health systems have strong financial incentives to approve only cost-effective drugs and interventions including lifestyle interventions. At least, that is the theory …..

From what we would pay in taxes compared to what we pay for premiums either through work or through the ACA, it would even out. Mention a healthcare tax and of course, most have knee-jerk reactions without basis for alarm. Just look at the satisfaction of the Canadian or Australian models of healthcare — few are complaining about the taxes they pay to support a system of equality and worry-free healthcare when it is needed. Greed drives the US mess. The best way to boycott the system is to self-educate and stay as healthy as you can because I doubt that in our lifetimes we will see a chiseling down of this profiteering system. I have a PPO plan from my job, but I have rarely used it. I believe in emergent medicine but am wiser to all the other deceptions: statins, SSRIs, neuro-spinal surgeries, beta blockers….screw that…and now the new buzz diagnoses are auto-immune and more designer drugs. It all comes down to diet, sharpening adrenal function and exercising your organs.

People who most complain about their coverage from health insurance are people who don’t even read their own policies and then are shocked when they get a bill. When a hospital charges $275 for one Tylenol tab you can wonder where to place blame. It is a triad of deceptive economics (Big Pharm, Corporate Hospital, Insurance) and they are all battling each other. When people run to the ER with a hangnail, it costs the patient a small copay whereas it costs the insurance company $15K. That is why premiums are high — and there is no fast fix to this conglomerate mess — and that is why the only inevitable solution is socialized medicine. Big Pharm needs to be completely disseminated — they are the top cause of this blanket of discontent with healthcare.

Agree with one exception. Most people really don’t understand anything about how insurance works or specifics about their policy because it really is complicated. Each company has contracted with different terms. You have HMO, PPO, etc. It truly is a mess

I agree it is complicated but it is not rocket science. AN HMO sequesters you to having a primary doctor in your immediate locale from whom all your care spans using referrals; and limits you to services that are under that blanket/ contract (physical therapy, radiology); the PPO plan gives you more freedom and you can even go out of state as long as that state has a plan with same plan carrier. HMO plans do not allow you to go out of the plan network whereas the PPO does give you out-of-network freedom (at an additional cost). The PPO plans are more expensive naturally. I would suggest you utilize the Nurses who work as Health Coaches at the insurance company. They are able to explain and are more dedicated to your achieving understanding. You have to play the game — but overall, people need to understand that NO ONE has any personal investment in your health. That is YOUR responsibility. If you trust any system, you get the results of your apathy. Same as if you say, “whatever you say” to a doctor who, for some reason, people think are omnipotent and flawlessly compassionate, you are screwing yourself.

It works in the sense that we (Canadians) have a lower infant mortality rate and longer life expectancy because all have equal access to health care. The cost savings are from dramatically less administrative costs as we have essentially cut out the insurance companies from the equation. But opponents quickly want to point out specific examples of long wait times or insufficient diagnostic equipment but you have to look at the health of the population as a whole and what is being achieved by the cost borne by the citizens. I like the example of Cuba who has nearly the same average life expectancy as the USA but is no where near as rich but they achieved it with a good nationalized medicare system.

I don’t want to be political here but politicians usually talk about cheaper drugs, more access to doctors, hospitals, etc. Let say drugs are cheaper but equally harmful, then are we trying to poison the population even more? Nobody talks about lifestyles fix diseases more than drugs and the majority of drugs are harmful and not helpful. So politicians should say raise the price of drugs and tell people to change their lifestyles.

We are starting to get more lifestyle advice because the companies are starting to realize with the new healthcare that it is going to cost. Where they really advocate lifestyle medicine is in single payer countries. We have the most expensive health care in the world and among the worst of all industrialized countries. The single payers do better.

Exactly! If you follow mainstream medicine then you are just drugging symptoms and not fixing the problems you have. I’m glad I “woke up” and started doing my own online research and taking better care of myself to improve my health. I know it may sound crazy to someone completely indoctrinated in our medical system, but not all MDs are really that smart or even read the latest research, which contradicts what they are practicing/preaching.

I do my own research too and that’s the way to go for the future. You can ask Google now about the symptoms you have and Google will search their database and find out reputable researches that talk about that symptom and treatment.

Agreed. Even on this site, when Dr. G covers some topic, I’ll check some of his references and make my own opinion. I’m in graduate school so I’m used to reading research articles related to microbiology, but I must say that I likely have read more diet and health-related articles than what I’m getting my PhD in!

Health and diet are extremely important for everyone on this planet and people need to educate themselves. In the age of information, there is no excuse to be ignorant!

I haven’t seen any mention of a movement called PlantPure Nation. It is a documentary by the same name, a website, a cookbook, and much more. Here is how they describe themselves:

“Behind the feature documentary film PlantPure Nation is a team of dedicated and passionate people working to spread the film and its message to cities around the world. PlantPure Nation has also launched a grassroots, community-­based strategy that engages millions of people everywhere to bring the message of plant­based nutrition to family, friends, and neighbors.”

This movement was started by Nelson Campbell, a son of Colin Campbell. I’m quite impressed with what they have already accomplished and the direction they are moving. Several of the people involved will be at Dr McDougall’s weekend retreat or meeting in September, including Nelson Campbell, T Colin Campbell, Kim Campbell and others.

There is also going to be someone representing the fourth largest health insurer in the country, based in Florida, and it is getting onboard training doctors in WFPB. Apparently this insurance company is like Kaiser Permanente, and has its own hospitals and clinics. Sorry I don’t have the name of this company and don’t have time right now to look it up, but if you go to McDougall’s website and look for their next event weekend you’ll find an impressive list of names, including someone representing this company.

PlantPure Nation even has a kickstart program where you can buy meals that meet the requirements of WFPB, to get you started on eating a great diet as you learn.

Regardless of peer review, IMHO, the results of a study only counts as science when there is no hidden agenda slanting the results. So if the public is ever going to have any hope of following the best science available in their personal habits as well as developing public policy, we have to know where the money is coming from. I would say that the best way to accomplish this is to pass a sunshine law requiring every person and organization that engages in or funds health research to disclose their funding source. This would include intermediate organizations so that research money can’t be laundered and sanitized. Then we could connect the dots to find out who is actually pulling the strings.

But we know who butters the bread of those responsible for passing the laws, so never mind. Just really glad that we have someone like Dr. Greger who is dedicated to finding the truth (as best as we can discern it) rather than personal enrichment to help us navigate through these toxic waters.

Dr. Greger’s comments are very valid and very important. Another example (one of many) is the secret rebate program from the company that makes Lucentis, a drug used to treat macular degeneration and other eye conditions. As reported in the New York Times http://www.nytimes.com/2010/11/04/business/04eye.html, participating physicians get bonuses for increasing quarterly use of the drug and for reaching certain use targets. This incentivizes using Lucentis, which costs nearly $2000 per dose, rather than off-label Avastin, which costs about $50 per dose, though a major study found no difference between the two in safety and effectiveness.

Which is worse, these so called rebates, or big pharma gouging prices? Or, are they one in the same? Why is the Epipen, a life saving device, now 400 to 600 dollars? And the say the robber barons are all on Wall Street.

I think pharmaceutical companies try to make as much money as possible by a wide range of strategies. Though they claim to be in the business of finding cures to diseases, more accurately they are in the business of making money. Their products (or at least some of them) do have value, but their owners (usually shareholders) demand that they get maximum return on investment. Physicians, however, have many societal prerogatives, including good incomes and lots of professional autonomy, based on the presumption that they will abide by the professional standard to have patient interests come first. Yet, I am sure that no physicians inform patients if they are participating in kickback programs like the Lucentis incentive program, a program designed 1) to influence physician choice against public health interest and perhaps against patient interest and 2) only benefits the doctor and has no benefit for patients.

Its a drug-delivery device trademark holder taking advantage of name recognition among doctors and patients for short term gain. Epinephrine (good ole’ adrenaline) was first synthesized in 1904, Epipen type autoinjectors have been around for 36 years, and identical dosage branded generic (Adrenaclick, about $140) and “epinephrine authorized generic” auto-injectors are available. With off-patent drug compounds, the FDA can approve pharmacist substitution with generics, but law and regulation are much less friendly to alternative drug delivery devices. Hence, pharmacists can fill prescriptions for “epinephrine auto-injector” or “generic Adrenaclick” with the less-expensive alternatives, but not if the doctor absent-mindedly writes a prescription for “Epipen”.

Given alternatives are available, the situation is not unlike if Kimberley-Clark decided to charge over four times as much for branded “Kleenex” products, when there are functionally identical facial tissues available. Consumers understand household goods, and would vote for alternatives with their dollars. In medicine, companies can take advantage of consumer ignorance and physician complacency.

It’s a good idea to learn the generic name for any prescription drug you take. Not only can a patient ensure they aren’t being gouged for an off-patent drug, but the published research always uses the generic name (as brand names differ country to country) should you wish to learn more about mechanisms and efficacy (to the extent publications can be trusted).

Towards the end of the article, before the references, there is usually a conflict of interest section where potential conflicts of interest are stated. If you really want to dig in deeper, check some of the other articles the last author has published in the past – look for conflicts of interest there as well. The last author (farthest to the right) is usually the principal investigator and the first author (farthest on the left) has done most of the work on the paper.

Conflict of interest is not the only consideration that should be made though. The tricky part, in my opinion, is if you have a paper that is making claims that you question but there are no conflicts of interest, then you need to look into how the study was performed and check the data/results. Epidemiological studies CAN have fundamental design flaws which would invalidate some claims made by the authors – at least in my opinion.

Main stream medical studies are sometimes designed to automatically show failure of inexpensive natural remedies in our fight against disease. For example, when the establishment wanted to disapprove Linus Pauling’s use of ascorbic acid to fight cancer, they did not use the same “route of delivery”, the same “dosage”, or the same “frequency”. As a result they gleefully disapproved Linus Pauling’s use of ascorbic acid as a good health substance. The same could be said for cannabis oil, and maybe even laetrile. If the establishment is willing to use fraud to promote their own products, they will also use fraud to disprove simple and inexpensive remedies in order to kill any opposition to their own schemes.

I am not sure that mainstream medicine has “disapproved” or even attempted to disprove Linus Pauling’s claim that use of ascorbic acid can benefit health. The facts are more nuanced but do not make for an exciting story. The Linus Pauling Institute (at Oregon State University) has a balanced (and interesting) discussion of this issue here:http://lpi.oregonstate.edu/mic/vitamins/vitamin-C/pauling-recommendation

In the interests of full disclosure, I should note that I take a 500mg vitamin c tablet twice a day plus a multivitamin which also contains vitamin C. Pure AA powder is probably better if one can obtain it.

If you scroll further down that page, you will find a description of trials to assess the effectiveness of intravenous vitamin C therapy:.
“These pilot and phase I study results motivate larger, longer-duration phase II clinical trials that test the efficacy of intravenous ascorbic acid in disease progression and overall survival. Such phase II clinical trials are currently under way (122). Because different cancer subtypes may be recalcitrant or require different doses of intravenous vitamin C, phase II trials are necessary before use of intravenous vitamin C as an anti-tumor agent can be fully realized (123). For information about the use of high-dose intravenous vitamin C as an adjunct in cancer treatment, visit the University of Kansas Medical Center Program in Integrative Medicine website.”

None of this supports claims that that the FDA or the US Government generally is trying to prevent investigation of vitamin C therapy.for cancer treatment.

The problem with Pauling’s orthomolecular nutrition approach with ascorbate is that the body actively excretes excess, perhaps to avoid its prooxidant effects catalysed by transition metals like iron. You can’t get theraputic concentrations by the oral route. There has been significant research interest in using intravenous ascorbate to potentiate prooxidant effects of cytotoxic chemotherapy. Its a cheap adjuvant and any oncologist can prescribe it. But, because there’s no patent on IV ascorbate, there’s little private funding for big trials, or for marketing the approach to doctors.

Hi Tom, I didn’t see your post until today. I don’t usually have cold or flu but every few years I have one and it’s tiring enough that I have to take time off from work. Anyway, I used a mushroom supplement that pretty much eliminates this cold / flu and I don’t even have one anymore. A couple of times I felt like I am about to get sick and my immune system kicks in and it’s all gone the next day when I get up. OK, so I usually don’t talk about supplement or what I take – sound like a salesman – but reading your post that you said that you get cold / flu regularly 3-4 times a year and that’s a lot, I just want to help you … because you seem to be a very nice man :) So I use a mushroom supplement from Garden of Life, it’s all vegan and it’s a blend of many mushrooms. There is 2 types at GoL and I buy the cheaper one. Oh I buy through Amazon.com and you can read the reviews from people swearing they got off cancer and things like that. I always take rec on supplement from people with some skepticism but I can attest that this supplement works for me. Everybody is different and what works for me may not work for you and so this is just a suggestion for you to check on it. Alternatively, you can eat a lot of fresh mushrooms and mushroom is good the immune system and I do eat a lot of mushrooms myself but the supplement works better (it’s probably more nutrients dense and it’s a blend of many mushrooms that are not easy to find on the market).

P.S. I cannot believe that I have been banned from this forum because somebody didn’t like what I posted, so I have to post as a guest.

Most of it started when the drug companies started donating huge amounts of $$$$$ to the medical schools. The drug companies gained control of what was taught. So the good doctors did what they were taught. Or brainwashed to believe. Anyone in a religious cult for up to 10 years is well known to be indoctrinated into that organization. That applies to doctors too. By the time they get ready to practice any independent thought is gone. Then for about 40 years the AMA ruled with an iron fist. The state medical boards followed too. Any doctor in that period that did not follow AMA guidelines were prosecuted and driven out of practice and some into jail. There were many great doctors in that time with exceptional medical knowledge to help people anyway they could. But they were not allowed to. Today the FDA is doing the same thing. It amazes me how many FDA approved drugs end up killing people before the FDA will pull them from the market. They should not have been there in the first place. If you suggest that food, vitamins, minerals or herbs may work the FDA is all over it in a nano second. Absolute proof the FDA is protecting the drug companies. Many doctors are caught in between what is right and what they may get prosecuted for.

Your last sentence speaks volumes, and most are unaware of it. It’s called “defensive medicine.” I’ve had a cardiologist admit to me regarding a patient’s treatment, that prescribing the medication was “doing his due diligence” Exactly what he meant was he was covering his butt legally; following protocol. He knew the medication has side effects such as lethargy, muscle pain, diminished sexual performance, brain fog, and on and on. But, its been shown to prevent the worst symptom of all, death. So he felt he had no choice.

Like anything else in life, there are good doctors and bad ones. The bad ones are just running a business. The business of medicine. The good, as you say, are so restricted, their hands are tied by regulation, protocol, fear of malpractice suits, etc. There’s gotta be a better way. And so the search continues…

Exactly… to avoid being sued in Australia at least, one must practice ‘as a similar doctor would have done in the same situation’… We have to disclose all available options (even ones we may not believe in) almost in fear of that one family member/friend etc that says ‘but why didn’t you give XYZ’… It’s quite scary..

This is an eye opening video and very interesting discussion. I as a volunteer dietitian moderator trained in UK really appreciate Dr G. educational videos. When I moved to the USA I realized how the pharmaceutical companies had power over medical industry. The amount of advertisment that there are on TV for drugs and medication is mind boggling. However, it is great to know there are so many good Drs such as Dr Greger, Dr J. Fuhrman, Dr McDougall, Dr Cald Well Esselstyn , Dr Neal Barnard, Dr Ornish and many more that are out there with interest of making change for better in the lives of their patients. They are committed to “healing not dealing” my own quote!

Terry you said ” It amazes me how many FDA approved drugs end up killing people before the FDA will pull them from the market.” I believe that the reason is this. – The FDA works for the drug cartel. They have to leave them on the market so the drug companies get their money back before they take them off.

Yes, and get this: BPA was originally made as a chemotherapy agent I forget which Pharm co) . They made millions of tons of it before they realized it was carcinogenic in itself in advanced clinical trials, so what did they do to regain the loss? They sold it to DuPont who started making hard plastics from it — so now that carcinogenic chemical is in everything from your plastic computer, phone, remote control, car dashboard, picnic dishes, water and beverage bottles, food containers, etc, etc, and in digital inks for receipts from cash registers. And it does leech into the system. It is found in urine tests at high amounts in most people.

Several years ago I was working as a commercial photographer in the Research Triangle in Raleigh, NC. I stopped on a public street and took pictures of a large building about half a mile from the sidewalk. Six renta cops in two cars showed up immediately and hassled me for about 20 minutes before letting me go. Turns out the building I took pics of was a GlaxoSmithKline research facility! Why were they so nervous and upset?

I’m not sure about that specific location, but I know a few research centres that have to move regularly and disclose their locations otherwise they get broken into and trashed by animal rights activists…

The problem is more than just corporate greed but the decline of moral in the entire society that is hooked on drugs, and the belief that drugs will take care of every illness. So at the instant somebody has a pain, rather than finding out the reason to fix it, they just pop a painkiller pill into their mouth. If they have weight problem (except for medical reason), rather than exercising or controlling their diet, they will pop a pill in their mouth that is supposed to burn fat. I don’t know what is the real solution to all this but we can start with a brave leader who can talk us out of all of this madness. Unfortunately, I don’t see this kind of leader in the upcoming election. Companies will sell anything people are willing to buy – so is capitalism. This country thrives on capitalism and free enterprise so that’s not where the problem is. But consumers and people need to be more educated and smarter in their choice.

Just take an example, we have free TV, at least for the 3 main news networks. How do they become free? Through advertisement of course. I never buy anything advertised on TV because it’s all crap but some people do, enough so that the news network can survive. I know there are a lot of craps on the TV but also useful programs. So those people who buy those craps actually subsidize other useful programs for the people who don’t. Hopefully “people who buy craps” are not too many but unfortunately they are including those who buy drug craps. I don’t understand why people are buying drugs advertised on TV. These drug ads always follow by a long laundry list of side effects. For instance, an arthritis drug can cause side effects such as liver, kidney damage and tuberculosis. Hmm, what does tuberculosis have to do with arthritis? To cure arthritis, the drug is called broccoli.

It’s also lack of intelligence and common sense. Millions go to Church and pray to a “Supposedly good God”. Then after that they go to McDonald’s, KFC, etc… to feast on cage-raised, brutally tortured, burnt meat of powerless, defenseless animals/kids. Even when I send them videos of inside the concentration torture factories, they either don’t watch it because they are too sensitive or don’t care. Well, if you don’t care, don’t go to church, because it’s oxymoron.

Our governments, whichever side of the pond you are on, are tacitly complicit in some of the worst crimes in humanity. This is the biggest conflict if interest. Some doctors aren’t likely to be able to be honest, when their paymasters, the drug companies regularly commit crimes against humanity, by fraudulently misleading hundreds of millions of potential “customers” about the results of their drug trials, their efficacy and their dangers.

Proverbs 1:11 If they say, Come with us, let us lay wait for blood, let us lurk privily for the innocent without cause:
Proverbs 1:12 Let us swallow them up alive as the grave; and whole, as those that go down into the pit:
Proverbs 1:13 We shall find all precious substance, we shall fill our houses with spoil:
Proverbs 1:14 Cast in thy lot among us; let us all have one purse:
Proverbs 1:15 My son, walk not thou in the way with them; refrain thy foot from their path:
Proverbs 1:16 For their feet run to evil, and make haste to shed blood.
Proverbs 1:17 Surely in vain the net is spread in the sight of any bird.
Proverbs 1:18 And they lay wait for their own blood; they lurk privily for their own lives.
Proverbs 1:19 So are the ways of every one that is greedy of gain; which taketh away the life of the owners thereof.

The problem is worse than Dr. Greger states in that federal funding also causes a bias in all science research. In particular, the federal government funds researchers that get positive results not negative results. Therefore because of publish or perish there is a lot of unverifiable research published in scientific journals. For example cancer research was discussed years ago on the front page of the Wall Street Journal where commercial companies said that they started with university research but found that much of the published research was not reproducible. Later it was published that there was a massive problem with cell culture contamination especially with HeLa (Helena Lackey cervical cancer cells) so that the published research was frequently on a different cell line than what was published.

Hence why there is complete loss of trust in medical care and government agencies (FDA, USDA, EPA — they are all shills now, their palms so easily greased by the industries). There are no gatekeepers anymore. This free market will be the demise of us all unless we reject all allopathic medicine. There are few healers left. There is no vocation, no ethic, no self-respect. Profits over People is in full throttle right now.

I think that the problem is more than just corporate greed or people stupidity or laziness but it has more to do with our culture of sciences. So people don’t think what they eat or how they live that are the sources of their health problems in the first place. Rather it is that bad things do happen, it’s an act of God or Nature whatever that may be and nothing we can do to avoid it but we can fix it with a pill or a machine. So we pop a pill in our mouth to fix this, another pill to fix that, and a third pill to fix the side effects of the first 2 pills.

I don’t think that all scientists and doctors out there are all trying to harm people on purpose. Rather it is due to their ignorance and lack of common sense no matter how smart they are. Check this lady, she is the President of some big drug company. She quits her job to take care of her sister who has cancer and she will enroll her sister in a clinical trial of a new drug. Obviously she wants to help her sister and not harm her. She looks very compassionate and I don’t think she is a bad person. But I don’t think she is aware of eating the Daily Dozen to prevent cancer in the first place, nor she can be convinced if you tell her about it.

Dr Greger often tells the story of sciences trying to find out what substance(s) in a given food is curing or preventing diseases so that they can extract and put it into a pill. But often, this does not work because it’s the synergy of many nutrients and not just one. So Dr Greger said why don’t we just eat the whole darn food while waiting for sciences to find out how.

Fortunately something deep inside myself, held me close to the truth. As
a child I had no option but to accept this OHSO smart doctors
treatment, but as I became an adult, I could decide. Now the only thing
useful a doctor has ever given me, is a medical certificate for my
employer. Never has a doctor asked about my psyche or my diet, NEVER,
for they are just side affects…

Grad school in biomedical research effectively screens out individuals for whom personal wealth is a primary motivator. Long and irregular hours, low pay, the prospect of years of post-doctoral research before any tenure track position accepts an application, all mean that those who choose careers in research are not doing it for material gain, at least at the onset. The problem arises when they find their tenure track position and must spend a large amount of time applying for grants and other funding sources to keep their laboratory running.

The medical school screening system seems less effective at excluding applicants for whom material gain is a primary reason for entering the profession. There are many, many conscientious doctors in the world who sacrificed a large fraction of their lives to achieve competence, are on-call to rush to the hospital in the wee hours, and put patients first. And then there are doctors happy to set up pain clinics and prescribe Vicodin and Oxycodone like candy, with little regard for the life-altering and shortening struggles they are subjecting patients to. The medical curriculum should change to emphasize lifestyle/prevention strategies, even if this means more time per patient and less income. But perhaps the medical school application process should change more.

Consider Hospitals associated with Medical Schools….The Physicians are commonly Professors (Associate Professors, etc.) in the Medical School and often use (steal) Test Results (Labs, CT’s, MRI’s, etc,) to teach their students. Physicians also send in their residents to do their work – abandoning the patients for the Residents to get experience – at the Patients Expense. Add to that that these Physicians are doing research with their patient’s labs and outcomes.
Patients are paying for professional care – not getting it – and the services they pay for are free game for teaching and research.

The Comments Section is getting to be a complete waste of time due to the incessant comments of one (and occasionally more than one) inane person. I used to find helpful and clarifying information in the Comments Section, but now it is dominated by contrarian nonsense and off topic drivel. I suspect that someone is getting paid by the comment to disrupt this site or merely has a psychological need for attention.

It would be helpful if the web designer would allow an individual to block (on their computer only) all comments from a specific member and all replies to that member. There may be other solutions, but as it stands now the Comments Section, which was once an important source of supplementary information, is now a platform for diluting and diverting the message.

Hi there, actually you are able to block a user, though I’m not sure that it blocks all replies. If you go to one of the user’s comments and hover over it, you will will see a tiny minus sign and down arrow appear above the comment on the right side. Click on the arrow – you can then block a user or flag a comment as inappropriate. We want this to be a welcoming community and one where you can continue to learn and connect with others; we are sorry that you’re feeling frustrated. If for some reason the blocking mechanism does not work for you, please send us a message.

I have a question about the conditionally essential amino acids: carnitine, taurine, creatine and carnosine. Most vegan sources will say that the human body synthesize enough of these and some say that only children, pregnant women, and athletes need to supplement taurine. However, non-vegan sources will sometimes say that these amino acids are important shortcomings of a vegan diet. There is not much information on the internet and I know Michael Greger is also of the opinion that we produce enough ourselves (unless one has a rare condition). Is there enough scientific evidence that shows these conditionally essential amino acids are indeed synthesized adequately in the human body? I found non of the sources I read persuasive in explaining one of the two positions. What is the current balance of evidence (if there is any)? I would very much like to know if dietary carnitine, taurine, creatine and carnosine are needed for optimal health. Optimal health also seems to be one of Michael Greger’s main interests and therefore I would love to see this topic covered and discussed more elaborately because I don’t know of any plant-based doctor that covered this issue comprehensively while it is often brought up by critics of a near or completely plant-based diet.

Thanks WFPBRunner for your tip! However, the question in the way I addressed it is not covered on this website, which is the reason I asked it here. The video “When Meat Can Be a Lifesaver” primarily discusses the conditionally essential amino acids in the context of a rare genetic disease. Optimal levels in normal people are not discussed since Greger only touches very briefly upon my question in that video by saying: “Thankfully vegetarians are animals too so they make it themselves … humans produce all these compounds on their own”. For this reason, I proposed to cover this topic more elaborately and with the focus on optimal health in the same way as in other videos the aspect of optimal health is scrutinized (e.g. the videos on cholesterol that show plant-based eating is the most efficient way to limit this risk factor) to come to the conclusion that plant-based eating is the best way to go. Maybe we do indeed make enough of the conditionally essential amino acids, but perhaps a fully plant-based diet isn’t so perfect in regards to optimal levels of carnitine, taurine, creatine and carnosine. Plant-based eating is (practically always) the solution to most of the issues discussed on this website and therefore it would be very interesting to delve deeper into the topic of optimal levels of carnitine, taurine, creatine and carnosine in normal people, pregnant women, babies, and athletes as plant-based eating may hinder the human body to maintain optimal levels of the conditionally essential amino acids. I’m very curious if even anybody knows more about this and it would make me even happier when Michael Greger would cover this topic.

I suppose he could cover it again. Maybe there is more information but for me he is pretty clear. As animals we make all the amino acids, including the essential amino acids, and there is no need to supplement. Again a varied WFPB diet is important as well as enough calories.

I’ll do a quick search for any new research articles and get back to you if I find any.

Dr. Greger is vegan — a choice he made both for health and philosophical reasons. As the public health director of the Humane Society, he also doesn’t want to be a hypocrite by eating meat. But there are some downsides to avoiding animal foods. He addresses these issues on his website, and in his book. Two nutrients of great concern are B12 and carnitine.

“B12 is a critical issue for anyone eating a plant-based diet even ovo-lacto vegetarian or flexitarian diets,” he says.

“You need a regular reliable source of vitamin B12. It’s absolutely critical. I have these horrific videos showing people going blind, people with spinal cord degeneration, people getting paralyzed, and people dying from not having enough vitamin B12. It’s one of the two vitamins not made by plants. One is vitamin D… the other is vitamin B12 … I recommend at least 2,500 micrograms once a week.”

One of the problems with B12 is that it’s a very large molecule, and unless you have an intrinsic factor to enhance the absorption in your intestine, it’s not going to be absorbed well. So oral B12 typically doesn’t work well.

Sublingual drops and intramuscular injection have better absorption rates. The 2,000 micrograms per week is the oral supplement dose Dr. Greger recommends, which is about 2,000 times the amount you actually need every day. Only 1 percent gets through the intestine, which is why you need such a high dose. Fortunately, you cannot overdose on B12, so you’re better off erring on the high side.

And then the carnitine, an animal protein essential for the transport of fatty acids into the mitochondria. The enzyme carnitine palmitoyltransferase is upregulated by about 20 percent in people who eat plant-based diets, but the reason is still unknown. It could be due to the fiber content, or perhaps the microbiome effect.

“The reason carnitine is in muscles, is in meat, is because animals make it. We are animals and we make it, too … There are enzyme systems that actually create carnitine in our body … About one in 20,000 to 30,000 births has a deficiency in creating carnitine, but would never even know it if they ate meat.

If they’re eating meat their whole lives, they’re getting carnitine this way instead of their own body making it. Should they go vegetarian, they’re going to end up in the hospital … So what do they do? They take carnitine supplements and they’re fine.”

Thanks Jimmy for your comment. I know this text as I’ve come across it once. Similarly as I said to WFPBRunner Greger focuses again on the rare genetic birth defect that makes it difficult for one to create carnitine, but he doesn’t discuss the topic in a way that it answers my question.

I think carnitine is mentioned in his book “How not to die” although I am not sure about. But he answered about this question during the interview with Dr Mercola.

“The reason carnitine is in muscles, is in meat, is because animals make it. We are animals and we make it, too … There are enzyme systems that actually create carnitine in our body … About one in 20,000 to 30,000 births has a deficiency in creating carnitine, but would never even know it if they ate meat.

If they’re eating meat their whole lives, they’re getting carnitine this way instead of their own body making it. Should they go vegetarian, they’re going to end up in the hospital … So what do they do? They take carnitine supplements and they’re fine.”

Thanks again Jimmy for your effort. I’m familiar with the vegan-supplement-checklist.com. I appreciate you linking me to that information and the website itself, however it concerns a blog and while blogs can be very good sources, I don’t find the information on that particular page sufficient enough to derive a conclusion from.

I’ve tried searching the online university library with my student account but most studies I found seem to suggest that further studies are needed. For example this study from 2015 (http://www.koreascience.or.kr/article/ArticleFullRecord.jsp?cn=HGSPB1_2015_v28n3_404) said: “Taurine has a number of features and functions, including conjugation with bile acid, reduction of blood cholesterol and triglyceride levels, promotion of neuron cell differentiation and growth, antioxidant effects, maintenance of cell membrane stability, retinal development, energy generation, depressant effects, regulation of calcium level, muscle contraction and relaxation, bone formation, anti-inflammatory effects, anti-cancer and anti-atherogenic effects, and osmotic pressure control. However, the properties, functions, and effects of taurine require further studies in future.”

This much older study from 1985 (http://europepmc.org/abstract/med/3909770) concluded: “Evidence is strong that taurine is vital in maintaining retinal function, which may explain why taurine is so abundant in human breast milk. Prolonged TPN feeding of infants demonstrates the importance of taurine in retinal development. We have begun to appreciate the role of the kidney in conserving taurine and how this is perturbed in the neonatal period. Taurine has recently been added to infant formulas (about 50 mg/L). Cataloging what we know of taurine function, however, produces a list of “maybes.” Now is the time for exhaustive, careful taurine research that will produce more definite answers.”

These are just two examples that describe the important function of taurine and its contribution to normal growth, but they represent more studies that made me interested in the optimal levels of carnitine, taurine, creatine and carnosine. Since I couldn’t find a clear conclusion, there probably isn’t one out there (yet). However, maybe others on this website have better insight into the scientific information about this topic.

According to LivingStrong, there are actually 10 essential proteins that the body cannot produce but has to get from foods. Vegans can get them from plant foods if they pay attention to combine sources of protein from vegetables, legumes and grain. They cannot simply eat a few plant foods and count the amount of protein and call it done.

Jimmy: Your understanding of protein and plant sources of protein is several decades out of touch. The following is a good protein 101 article that will explain why your statement about protein combining is incorrect: http://michaelbluejay.com/veg/protein.html

Actually there are 11 amino acids that your body can’t make by itself and so are essential in humans. However, while the body cannot make methionine and cysteine, it can convert one to the other. The same is true for phenylalanine and tyrosine. So for these two pairs it is only important that you get enough in total of the two amino acids in the pair. It is for this reason that you will sometimes see the number of essential amino acids given as 9, but there are 11 amino acids listed. As Thea says, the myth of the need to combine different plant proteins in order to get “complete” protein arose was debunked decades ago. Dr. Greger had a good video covering the topic. Yet like any good zombie the incomplete plant protein/protein combining myth refuses to die because it is already dead, but just doesn’t know it. Here is what is absolutely known to be facts about plant protein.

1) Every single vegetable and very nearly all fruits contain every single essential amino acid (EAA). No vegetable that I looked at was completely missing any of the EAAs.

2) All starchy and non-starchy vegetables, grains, and legumes contain not only significant amounts of total protein but significant amounts of each of the EAAs as well.

3) The large majority of vegetables and grains and all legumes are sources of complete protein all by themselves.

1 and 2 can be see to be true by inspection. Just go to cronometer.com and enter into the log section a significant amount of any single plant food (to avoid round off errors) and the protein section will show some amount of protein and some amount of each of the EAAs. 3 will take some explanation.

The traditional definition of a complete protein is measured by how closely it matches the amino acid profile of human flesh. But of what importance is that. Decades of metabolic ward studies have determined the number of grams per kilogram of total protein and milligrams per kilogram of lean body weight for each EAA that should be consumed each day. The FDA and the WHO then basically doubled what the studies said was required to make sure that everybody under the protein requirement bell curve was getting enough. So the functional requirement of your diet with respect to protein and each of the EAAs is that by the time you have consumed all the calories you need to maintain weight you have also consumed enough total protein and each of the individual EAAs to meet the RDI.

So functionally a food is complete if for a given amount it provides a higher percentage of the required amount of protein and each EAA than the percentage of daily calories.

A couple of quick examples: One large white potato supplies 14% of a 2000 calorie diet. It also supplies 7.5 grams of protein, which is 14% of the 54 grams protein needed. And the lowest percentage of the EAAs supplied by that potato is 11% of the daily requirement for Leucine. So a little low, but well above the amount required for the large majority of people. The amount of every other EAA is higher with the top being 23% of required amount of Cystine.

2 cups of sliced carrots only contain 6% of a 2000 calorie diet, but they also contain 5% of total protein, and the lowest EAA is methionine at 6% and highest is Cystine at 62%. So carrots, not normally viewed as any source of protein are actually a source of complete protein for all but a very few with unusually protein metabolism.

And lastly a cup of black beans contains 12% of the calories, but contains 33% of the necessary protein and 27% of the RDI for methionine. So not only are black beans complete, they are a super complete source of protein. In fact eat too many legumes and it is easy to get too much protein. But reasonable amounts of legumes will easily elevate the amount of protein and the EAAs of the overall diet to well above the minimum required. No special protein combining needed.